Eilander H J, van de Wiel M, Wijers M, van Heugten C M, Buljevac D, Lavrijsen J C M, Hoenderdaal P L, de Letter-van der Heide L, Wijnen V J M, Scheirs J G M, de Kort P L M, Prevo A J H
Rehabilitation Centre Leijpark, Division Research, Tilburg, The Netherlands.
Neuropsychol Rehabil. 2009 Jan;19(1):1-27. doi: 10.1080/09602010701694822.
The objective of the study was the validation of the Post-Acute Level of Consciousness scale (PALOC-s) for use in assessing levels of consciousness of severe brain injured patients in a vegetative state or in a minimally conscious state. A cohort of 44 successively admitted patients (between 2 and 25 years of age), who were treated in an early intensive neurorehabilitation programme, were included in the study. Each patient was examined, using the Western Neuro Sensory Stimulation Profile (WNSSP) and the Disability Rating Scale (DRS), once every two weeks resulting in 327 examinations (all videotaped). To determine the reliability of the PALOC-s, six observers rated one videotape of each patient. One of the observers rated the same tapes a second time, 3-4 months later. Validity was determined by correlating 100 ratings of one observer with the scores on the WNSSP and the DRS. To determine the responsiveness of the PALOC-s, the size of change between the scores of the first and last examinations was calculated. The inter-observer correlations and agreement scores varied between .82 and .95. The intra-observer correlation and agreement scores varied between .94 and .96. Correlations with the WNSSP varied between .88 and .93, and with the DRS between .75 and .88. The responsiveness was significantly high (t=8.2), with a standardised effect size of 1.30. It is concluded that the PALOC-s is a reliable, valid, and responsive observation instrument provided it is administered after a structured assessment by an experienced and trained clinician. The PALOC-s is feasible for use in clinical management, as well as in outcome research.
本研究的目的是验证急性后期意识水平量表（PALOC-s），用于评估处于植物状态或最低意识状态的重型脑损伤患者的意识水平。研究纳入了44名连续入院的患者（年龄在2至25岁之间），他们接受了早期强化神经康复计划的治疗。每位患者每两周接受一次检查，使用西方神经感觉刺激量表（WNSSP）和残疾评定量表（DRS），共进行了327次检查（所有检查均录像）。为了确定PALOC-s的可靠性，六名观察者对每位患者的一盘录像带进行评分。其中一名观察者在3至4个月后再次对同一盘录像带进行评分。通过将一名观察者的100次评分与WNSSP和DRS的得分进行关联来确定有效性。为了确定PALOC-s的反应性，计算第一次和最后一次检查得分之间的变化幅度。观察者间的相关性和一致性得分在0.82至0.95之间。观察者内的相关性和一致性得分在0.94至0.96之间。与WNSSP的相关性在0.88至0.93之间，与DRS的相关性在0.75至0.88之间。反应性显著较高（t=8.2），标准化效应大小为1.30。得出的结论是，只要由经验丰富且经过培训的临床医生在进行结构化评估后使用，PALOC-s就是一种可靠、有效且具有反应性的观察工具。PALOC-s可用于临床管理以及结果研究。
